Three Fundamental Challenges in a DME Billing Industry

Helping patients live a comfortable life with the Durable Medical Equipment, the DME billing process is a complicated process. In a DME billing process where every step to getting paid relies on the previous communication, proper documentation, proper claims filing, etc the DME billing can be a pain for some of the healthcare providers. Especially, when it plays a vital role in the revenue generation and is also the backbone of the healthcare organization. Communicating across different healthcare departments and payers in order to make sure that all the vital information is accurately captured in each step of the process, the DME billing process is not as easy as it is seen.

A complete portfolio of a DME billing process not only ends with just taking the patient’s information and then filing claims but a series of steps which involves:

✓ New patient Entry
✓ Eligibility and Benefits Verification
✓ Prior Authorization
✓ Medical Coding
✓ Claims Submission
✓ Rejection Management
✓ Payment Posting
✓ Accounts Receivables Follow-up
✓ Denial Management
✓ Customer Service

Challenges in DME billing process:

✓ Incomplete documents — according to report incorrect or insufficient documents alone accounts for $2.6 billion of the total $3.2 billion in waste of the Medicare Trust Fund. Being one of the major challenges of DME billers, as it lay the foundation for the DME billing and collecting process ensuring proper and complete information related to the patients is vital. As even a slighted mistake can result in claims denial and losing a lot of time and money.

✓ DME coding errors- according to a survey done by the American Health Information Management Association (AHIMA), the 2 most top coding challenges a healthcare provider faces are; inaccurately applying the seventh character for trauma and fracture codes, inappropriately using procedure codes that drive a diagnostic related group. Along with misidentifying respiratory failure, mistaking the use of guidance tools, and insufficiently documenting devices, components, and grafting materials. Etc. As improper codes also lead to claims denials it becomes a critical factor in a DME billing process.

✓ Claims management- this is the most important step in a DME billing process where the submission of the claims is done. It is the gatekeeper ensuring claims that are made should be preceded further or not.

In fact, a seamless DME billing process has many other challenges too like:

✓ Inexperience billers and coders
✓ The complex prior authorization process
✓ Lack of software knowledge and many more

As the healthcare care industry, CMS rules, and its regulation are constantly changing it is becoming furthermore challenging for the healthcare providers to keep a track of and ensure a seamless billing process. This is why solving all your problems related to the DME billing process, outsourcing organizations are there offering a low service charge to ensure a seamless DME billing process.

With more than a decade of experienced DME biller and coders, this Revenue Cycle Management organization not only helps you in reducing your operational cost by 70% immediately but at this time also provides you with a FREE Telemedicine platform to increase the extent of your patient's intake.